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• W2029552347 abstract "Question: A 35-year-old woman (gravida 4, para 3) was admitted at 19 weeks' gestation with a 2-week history of constant epigastric pain associated with nausea, vomiting, and an isolated episode of melena. She denied use of nonsteroidal anti-inflammatory drugs. Her past history was unremarkable. On examination, her abdomen was benign and she was hemodynamically stable. Hemoglobin on admission was 7.9 mg/dL. Esophagogastroduodenoscopy demonstrated a 1-cm ulcer (Figure A, arrow) with no stigmata of bleeding overlying a 3-cm area of redundant gastric folds (Figure A, arrowhead). To exclude an underlying mass, linear array ultrasonography (Figure B) was performed revealing a 6 × 6-cm, inhomogeneous mass with irregular outer borders located in the proximal gastric body and extending to the spleen, left hemidiaphragm, and pancreatic tail. Fine needle aspiration (FNA) was performed. She subsequently underwent an en bloc partial gastrectomy and splenectomy. The gross specimen showing the resected portion of the stomach and the spleen (Figure C) and H&E stained section of the stomach (Figure D) are shown. What is the diagnosis? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. Endometriosis is defined as presence of endometrial tissue outside the uterine cavity. The pathogenesis remains unclear, but coelomic metaplasia (metaplastic transformation of the mesothelial cells) and retrograde menstruation with deposition of peritoneal implants remain the most accepted theories.1Witz C.A. Current concepts in the pathogenesis of endometriosis.Clin Obstet Gynecol. 1999; 42: 566-585Crossref PubMed Scopus (136) Google Scholar Gastrointestinal endometriosis is uncommon, but when present usually involves the rectosigmoid and less commonly small bowel, cecum, or appendix.2Macafee C.H. Greer H.L. Intestinal endometriosis A report of 29 cases and a survey of the literature.J Obstet Gynaecol Br Emp. 1960; 67: 539-555Crossref PubMed Scopus (199) Google Scholar It is usually asymptomatic, but may manifest as lower gastrointestinal bleeding, pelvic pain, constipation, obstruction, appendicitis, and rarely perforation. Endometriosis involving the upper gastrointestinal tract is very rare and may present as a submucosal lesion as above. Endoscopic ultrasonography is helpful in evaluating subepithelial masses that may arise from many etiologies, and FNA sampling may confirm the diagnosis as in this patient in whom decidua were identified in the FNA sample, suggestive of endometriosis. Given the concern of continued bleeding and/or perforation we opted for operative intervention and the surgical pathology confirmed endometriosis with the presence of endometrial glands (Figure D, arrow) and decidualized stroma (Figure D, arrowhead) forming a mass infiltrating the gastric wall and spleen. The presence of progesterone during pregnancy is supposed to reduce the size of endometriotic tissue; however, there have been case reports of perforation secondary to endometriosis in pregnant patients owing to extensive decidualization and infiltration of the wall of the intestine.3Pisanu A. Deplano D. Angioni S. et al.Rectal perforation from endometriosis in pregnancy: case report and literature review.World J Gastroenterol. 2010; 16: 648-651Crossref PubMed Scopus (59) Google Scholar Our patient did well after the surgery and delivered a healthy baby at term." @default.
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• W2029552347 date "2011-06-01" @default.
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• W2029552347 title "Unusual Submucosal Tumor in the Stomach" @default.
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• W2029552347 doi "https://doi.org/10.1053/j.gastro.2010.03.081" @default.
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